Suture anchoring assemblies and methods of use

ABSTRACT

A suture anchor assembly and methods of use will now are disclosed for the repair of human or animal tissue defects. The suture anchor assembly is capable of being inserted into a tissue or bone while also being able to create an expanded profile when subjected to a retrograde force. This expanded profile anchors the assembly into the tissue or bone by a changing of position of elements of the assembly relative to other assembly elements. Embodiments of the suture anchor assembly and methods are capable of precisely positioning assembly elements in the tissue or bone to effectively repair the defects. Some embodiments of the suture anchor assembly may include pliable buttons. And some embodiments of the suture anchor assembly may also include buttons made of bioabsorbable or resorbable materials.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation in part of U.S. patent applicationSer. No. 13/241,466 filed Sep. 23, 2011 which is a divisionalapplication of U.S. patent application Ser. No. 12/245,714 filed Oct. 4,2008, now U.S. Pat. No. 8,052,719 issued Nov. 8, 2011, which claimsbenefit of U.S. Provisional Patent Application No. 61/041,579 filed Apr.1, 2008, the entire contents of all referenced applications areincorporated herein by reference.

STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT

Not Applicable

REFERENCE TO SEQUENCE LISTING, A TABLE, OR A COMPUTER PROGRAM LISTINGCOMPACT DISC APPENDIX

Not Applicable

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates generally to a systems and methods forsecuring sutures and other materials during surgical procedures. Moreparticularly, embodiments of the present invention relate to systems andmethods for suture fixation and methods designed for the placement ofsurgical anchors for the attachment of tissues associated withorthopedic surgeries. Embodiments of the present invention also relateto systems and methods designed to reduce, or bring into closeapproximation, pieces of torn or damaged soft tissue to facilitatetissue repair and healing.

2. Description of Related Art

Open and arthroscopic meniscal repair has become a mainstay for theorthopedic surgeon. In the 1960s and 70s partial or total mastectomy wasthe norm. As arthroscopy and arthroscopic skills advanced arthroscopiccombined with open or all arthroscopic meniscal repair became thestandard of care. Multiple studies have demonstrated the ability of themeniscus to heal, particularly in the vascular zone which is in thefirst 3 mm of its capsular attachment. With advancement of arthroscopicmeniscal repair tools more and varying types of meniscal tears have beensuccessfully repaired.

The present weaknesses of meniscal repair systems are several. First thegold standard has been the “inside out” meniscal repair system. Withthis method, cannulae are passed through skin portals, and use longneedles with sutures attached that are passed through the cannulae,through the knee joint, across the defect and out of the knee to beretrieved through an open incision and then tied against the deepcapsular structures away from neurovascular structures. This techniqueallows for precise placement of sutures in the meniscus.

One of the problems associated with these types of procedures is thetime and number of intubations needed to perform the various proceduresendoscipically. In addition, this technique does not allow for preciseplacement of sutures thru the capsule, and therefore there is potentialfor neurovascular injury.

The outside-in techniques involve passing sutures through needles at thejoint line across the tear, and then tying one end of the suturestogether and tying the other ends of the sutures directly onto thecapsule. Alternative techniques allow the sutures to be passed acrossthe defect and tying the suture back on itself on the capsule. Oneadvantage to this technique is that there is a low risk of neurovascularinjury, since needles are passed thru precise thru the capsule.Potential disadvantages of the outside-in technique is that sutureplacement thru the meniscus may not be precise as well as difficulty inreducing the defect and opposing the edges while passing the sutures.

In the past 15 years “all inside” devices have been developed formeniscal repair. These devices were developed in order to obviate theneed for posterior corner incisions medial or lateral and to reduce therisk of neurovascular damage as a result of the surgery. These devicesare deployed through the arthroscopic portals and either oppose themeniscal fragments and/or push a pre-tied knot onto the body of themeniscus. The present devices have created articular lesions due toprotrusion as well as partially deployed devices that are proud.

Systems and methods such as that disclosed in U.S. Pat. Pub. No.2006/0178680 Nelson et. al. illustrate some embodiments of an all-insidesolution.

The all inside systems are limited by how accurate they are whenrepairing a meniscus and thus have never enjoyed as good a success ratesas the inside out devices referenced above. Because the all insidedevices are so large it is virtually impossible to accurately pass asuture and/or meniscal device into the under surface of the meniscus,thus the majority of the devices are passed on the top surface in anattempt to pinch the lower inferior portions together. This technique inactuality leaves the tear distracted on its inferior surface. Althoughmany devices have been fabricated for all-inside meniscal repairs, whichcan be done endoscopically without the open-skin incision, the incidenceof re-tear among patients who have undergone the procedure is higherover time compared with that for patients who were given inside-outpermanent sutures

There is a benefit therefore from providing a suture anchor assembly andmethods of use that allow accurate placement of the suture and sutureanchor. There is also a benefit from providing assemblies and methodsthat minimize the number of incisions required for use.

Bone Anchor Systems:

There are numerous bone anchors with sutures attached that allow tissuesto be approximated to specific bone attachment sites. Most systemsdeploy a three-step system wherein the hole is drilled, anchor placedand then the anchor holder removed and the anchor set by pulling onsutures. If the bone is of questionable quality, the anchor may onlytemporarily hold and loosen later through the rehabilitation phases.Also, if the first step of drilling a hole can be eliminated then itwould be expected that the anchor would hold more securely, particularlyin porous bone.

Systems such as those disclosed in U.S. Pat. Pub. No. 2007/0032821, Chaoet. al. and U.S. Pat. Pub. No. 2006/0217762 Maahs et. al. show anchorsystems that expand into an opening, however, they are not structured toopen into and secure an element in bone.

Other systems rely on an anchor to flip, based on a second suture beingplaced at the end opposite the attached suture. There are also systemsthat anchor by means of screwing in or anchoring by means of flexiblehooks.

There is a therefore a benefit from providing a suture anchor assemblyand method of use that can be easily inserted and deployed throughexpansion.

BRIEF SUMMARY OF THE INVENTION

The suture anchor assembly is an assembly that is capable of beinginserted into a tissue or bone in a forward direction while also beingable to create an expanded profile when subjected to a retrograde, oropposite direction, force. This expanded profile generally anchors andsecures the assembly into the tissue or bone by a changing of positionof elements of the assembly relative to other assembly elements. Thischanging of position creates an expanded profile of the assembly in thetissue which helps to frictionally engage the tissue and anchor theassembly. Embodiments of the assembly and methods of the presentinvention provide for the accurately positioning and of anchoring ofelements to fix sutures in tissue or bone. In some embodiments, thesuture anchor assembly has pliable elements and elements of the assemblyare secured into the tissue by a deformation of assembly elements.

In an example embodiment, the suture anchor assembly comprises a firstbody portion, a second body portion having a force connector and a meansto connect the first body portion and the second body portion whereby aretrograde force on the force connector causes the first body portion toengage a tissue and secure the suture anchor assembly in the tissue.

In an example embodiment, the suture anchor assembly includes the firstand second body portions being planar shaped and the suture anchorassembly further includes a cannula having a slot shaped hollow portionto receive the planar body portions whereby the position of the firstand second body portions can be controlled by the position of the slotshaped hollow portion.

In an example embodiment, the suture anchor assembly further comprises aneedle, a means of connecting the needle to the first body portion and aretrograde force element capable of connecting to the second bodyportion force connector.

In an example embodiment, the suture anchor assembly further includesthe first body portion being elongated, the means to connect the firstbody portion and the second body portion comprises a connectorconnecting a first connection point on the first body portion and asecond connection point on the second body portion and the location ofthe force connector relative to the first body portion and the firstconnection point causes the first body portion to pivot relative to thesecond body portion when a retrograde force is applied to the forceconnector.

In an example embodiment, the suture anchor assembly further includesthe first body portion being capable of compressing to form a front endand a expansion end and the expansion end of the first body portionbeing biased to expand whereby a retrograde force on the force connectorcause the expansion end to expand and engage the tissue and secure thesuture anchor assembly in the tissue.

In an example embodiment, the suture anchor assembly includes the firstbody portion being capable of being compressed to form a front end and aexpansion end, the means to connect the first body portion comprising acollar on the first body portion to receive the second body portion andthe expansion end of the first body portion being biased to expandwhereby a retrograde force on the force connector forces the second bodyportion to expand the first body portion whereby the expansion endengages the tissue and secures the suture anchor assembly in the tissue.

In an example embodiment, the suture anchor assembly comprises animpactor, an expandable first body portion having a distal collar and aproximal collar and a second body portion having a force connectorwhereby a retrograde force on the force connector forces the second bodyportion against the distal collar and a forward force on the impactortransfers the forward force to the proximal collar whereby the firstbody portion expands to secure the suture anchor assembly in the tissue.

In an example embodiment, the suture anchor assembly further includes adelivery rod and a means to connect the delivery rod to the forceconnector whereby a force applied to the delivery rod is transferred tothe second body portion.

In an example embodiment, the suture anchor assembly further includes ameans to retain the expansion of the first body portion to secure thesuture anchor assembly in the tissue.

In an example embodiment, the suture anchor assembly comprises a pliablebutton with a first body portion and a second body portion whereby aretrograde force on a force connector causes the pliable button todeform and engage a tissue and secure the pliable button in the tissue.

In some embodiments, the button is resorbable or bioabsorbable.

In some embodiments, the button is deformed by a forward force on thebutton which causes the button to deform and engage the tissue andsecure the button in the tissue.

In an example embodiment, a method of tissue repair comprises providinga suture anchor assembly having a retrograde suture, inserting thesuture anchor assembly into a tissue, applying a retrograde force on theretrograde force element to cause the suture anchor assembly to engagethe tissue and secure the suture anchor assembly in the tissue andanchoring the retrograde force element to secure the suture anchorassembly.

In an example embodiment, the step of inserting a suture anchor assemblyfurther includes inserting a needle connected to the suture anchorassembly and passing the needle and suture anchor assembly through thetissue.

In an example embodiment, the suture anchor assembly further includes afirst body portion connected to a second body portion connected to theretrograde suture and the step of applying a retrograde force on theretrograde force element further includes causing the first body portionto engage the tissue.

In an example embodiment, the suture anchor assembly is planar andfurther comprises a cannula having a slot shaped hollow portion toreceive the planar suture anchor assembly and the step of inserting thesuture anchor assembly further includes positioning the insertion of theplanar anchor assembly by the position of the slot shaped hollowportion.

In an example embodiment, the method of tissue repair further includesrepeating the step of inserting the suture anchor assembly and applyingthe retrograde force with at least one second suture anchor assemblyhaving a second retrograde suture and the step of anchoring theretrograde force element further comprises anchoring the retrogradeforce element to the second retrograde force element to secure thesuture anchor assemblies.

In an example embodiment, the step of inserting a needle includesinserting the needle through a cannula.

In an example embodiment, the first body portion is elongated and thestep of applying a retrograde force to the retrograde force elementcauses the elongated first body portion to pivot relative to the secondbody portion and engage the tissue.

In an example embodiment, the first body portion is capable of beingcompressed to form a front end and an expansion end, the expansion endof the first body portion expands when not compressed and the step ofapplying a retrograde force on the retrograde force element includescausing the expansion end to expand and engage the tissue.

In an example embodiment, the first body portion is capable of beingcompressed to form a front end and a expansion end, the first bodyportion is connected to the second body portion by a collar on the toreceive the second body portion, the expansion end of the first bodyportion expands when not compressed and the step of applying aretrograde force on the retrograde force element includes forcing thesecond body portion to expand the first body portion where the expansionend expands and engages the tissue.

In an example embodiment, a method of anchoring a suture into a tissuecomprises providing a suture anchor assembly with an expandable firstbody portion, a second body portion and a force connector connected tothe second body portion; inserting the expandable first body portion andsecond body portion of a suture anchor assembly into a tissue; expandingthe first body portion of the suture anchor assembly by applying aretrograde force to the force connector to secure the suture anchorassembly in the tissue; and attaching a suture to the suture anchorassembly.

In an example embodiment, the step of inserting the second body portionfurther includes applying a first forward force on a sharpened distalend of the second body portion and the step of expanding the first bodyportion further includes applying the retrograde force to a distal endof the first body portion and applying a second forward force on aproximal end of the first body portion expanding the first body portion.

In an example embodiment the step of expanding the first body portionfurther includes applying the retrograde force by forcing a wedge shapedproximal end of the second body portion into a collar of the distal endof the first body portion and applying the second forward force with animpactor whereby the retrograde force and the second forward forceexpands the outer dimension of the first body portion.

BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS

FIG. 1. A top view of one embodiment of the suture anchor assembly.

FIG. 1A. A top view of one embodiment of a button.

FIGS. 2A-2D. A top view of multiple embodiments of the button in aninsertion and deployed position.

FIGS. 3A-3B. A top view of one embodiment of the button in an insertionand a deployed position.

FIGS. 4A-4B. A top view of one embodiment of the button in an insertionand a deployed position.

FIG. 5A-5B. A side view of one embodiment of the button in an insertionand a deployed position.

FIG. 5C. A side perspective view of one embodiment of the suture anchorassembly with the button in a deployed position.

FIG. 6. A process diagram outlining one embodiment of the method ofoperating on embodiment of the suture anchor assembly.

FIG. 7A-7B. A top view of one embodiment of the suture anchor assemblybeing inserted and deployed in a meniscal repair.

FIG. 8. A process diagram outlining one embodiment of the method ofoperating on embodiment of the suture anchor assembly.

FIG. 9A-9B. A top perspective view of one embodiment of the sutureanchor assembly being inserted and deployed to secure a suture in bone.

FIG. 10A. A perspective view of an example embodiment of a tubularshaped button.

FIG. 10B. A perspective view of an example embodiment of a button shapedfrom a mesh material.

FIG. 10C. A perspective view of an example embodiment of a tubularbutton as it may be collapsed in an insertion profile when used with aneedle, a traction suture and a suture as inserted through a tissue.

FIG. 10D. A perspective view of an example embodiment of a tubularshaped pliable button as it may be deformed upon receiving a retrogradeforce.

FIG. 10E. A perspective view of an example embodiment of a tubularbutton as it may be deformed upon receiving a forward force.

FIG. 11A. A perspective view of an example embodiment of a pliable sheetas a button.

FIG. 11B. A perspective view of an example embodiment of a pliable sheetas a button as it may be collapsed in an insertion profile when usedwith a needle, a traction suture and a suture as inserted through atissue.

FIG. 11C. A perspective view of an example embodiment of a pliable sheetas a button as it may be deformed upon receiving a retrograde force.

FIG. 11D. A perspective view of an example embodiment of a pliable sheetas a button as it may be deformed upon receiving a forward force.

FIG. 12A. A perspective view of an example embodiment of a spiral shapedbutton.

FIG. 12B. A perspective view of an example embodiment of a spiral shapedbutton as it may be collapsed in an insertion profile when used with aneedle, a traction suture and a suture as inserted through a tissue.

FIG. 12C. A perspective view of an example embodiment of a spiral shapedbutton as it may be deformed upon receiving a retrograde force.

FIG. 13A. A perspective view of the example embodiment of the button ofFIG. 10A in a dilated anchor profile.

FIG. 13B. A perspective view of the example embodiment of the button ofFIG. 11A in a folded anchor profile.

FIG. 13C. A side view of the example embodiment of the button of FIG.12A in a dilated anchor profile

DETAILED DESCRIPTION OF THE INVENTION

A suture anchor assembly and methods of use will now be described indetail with reference to the accompanying drawings. Although embodimentsare described for the repair of meniscal defects, it is understood thatthe methods and systems described can be use for the repair of otherhuman or animal body defects. In particular it is contemplated thatother embodiments of the invention can be use for repair and sutureanchoring to bone or other tissues. Notwithstanding the specific exampleembodiments set forth below, all such variations and modifications thatwould be envisioned by one of ordinary skill in the art are intended tofall within the scope of this disclosure.

Throughout this description, a retrograde force means a force appliedgenerally opposite of the direction of insertion of the assembly.Additionally, the verbs anchor and secure as used throughout thisdescription mean to hold fast or otherwise fix or fasten.

Suture Anchor Assembly:

One embodiment of the suture anchor assembly is shown in FIG. 1. Thesuture anchor assembly 100 shown and described is a device that provideselements to allow new combinations of some features of the “inside-out”and “all-inside” solutions. This solution takes advantage of theaccuracy and reliability of inside-out and outside-in suture solutionsbut can result in a device with all-inside features once the system hasbeen deployed. Thus, by using this assembly outside incisions can beminimized while the accuracy and effectiveness of the inside-out systemcan be duplicated.

The assembly disclosed provides a solution that can be accurately placedaround the defect, can be placed with fewer incisions and can bepositioned to reduce the incidence of protrusions that may irritate thetissue or bone around the defect.

As shown in FIG. 1, one embodiment of the suture anchor assembly 100comprises at least one set of a retrograde force element 120, a button110 and a delivery system.

The retrograde force element 120 is connected to the button 110 by aforce connector 113. The retrograde force element 120 is used to deployand anchor the button 110. As shown in FIG. 1, the retrograde forceelement 120 may comprise a retrograde suture that provides theretrograde force and also secures that suture and anchor pair to anothersuture/anchor pair so that the defect is repaired or reinforced. Anytype of surgical suture is suitable for use as a retrograde suture withthis assembly. It is also understood that other types of retrogradeforce elements can be used to deploy the anchor and secure assemblyelements and tissue together. These other types of retrograde forceelements may include, but not be limited to other securing elements suchas rods, pins, staples and other materials that can transfer andmaintain a tensile force.

As detailed in FIG. 1A, the button 110 is a rigid or semi-rigid elementwith a force connector 113. The button 110 is shaped to change ortransform shape when a retrograde force is applied to the forceconnector 113. Although not required, this transformation can be donewith some degree of control of the profile of the button. This change ofshape allows the button 110 to anchor in the tissue and counter thatsame, or a different retrograde force. The button 110 can be made ofbiocompatible materials that include, but are not limited to metals,metal alloys or non-metallic materials such as nylon, polyethylene,polypropylene or any combination thereof. The force connector 113provides the connection through which forces are transferred to thebutton 110. Although shown in this embodiment as a suture tie for theretrograde suture, the force connector 113 can comprise any elementcapable of connecting the retrograde force element to the button in away that a tensile force can be applied and maintained on the forceelement. Suitable connection elements include, but are not limited tomating threads, clips, hooks, holes, permanent adhesive connections orany combination thereof.

In the embodiment shown in FIGS. 2A-2D, the button 210 comprises anexpandable first body portion 212 and second retrograde force bodyportion 211 and a means to connect the two portions. In this embodiment,the expandable body portion 212 is a generally elongated and pointedsection and the retrograde force body portion 211 is generally a broadsection. The expandable and retrograde force portions each have aconnection point and are connected to each connection point by aconnector 214. The connection points comprise a means of receiving aconnector such as a hole, slot or adhesive and the connector comprises ameans of connecting the two body portions such as, but not limited to apivot hinge or rivet. The retrograde force element in this embodimentcomprises a retrograde suture 220. The retrograde suture 220 isconnected to the retrograde force portion 211 of the button through theforce connector comprising a suture tie 213. This suture tie 213 can beany method of securing a suture to the body portion. The suture tie asshown in FIGS. 2A 2D comprises an off-center hole in the retrogradeforce portion 211.

The means to connect the body portions of the button can include anyconnecting methods that allow the two portions to pivot and/or rotateabout the connection points. For example, it is contemplated that theconnector 214 may be comprised of a protrusion, hook or other connectionelement on one body portion that is capable of being connected to acomplementary hole, slot or other connecting element on the other bodyportion.

The interoperation of the suture tie 213, the connection points and thetwo button body portions are such that a retrograde force on the suturetie urges the expandable body portion 212 to rotate or otherwise move ina direction at an angle different than the retrograde force. Thisrotation or movement causes an expanded profile of the button whichfrictionally increases the resistance that can be provided by the buttonand expansion suture. The elongated shape, where the length of theportion in an insertion position is greater than its width, of theexpandable body portion causes this expanded profile when the expandableportion is moved about the connector. This interoperation to cause theexpandable body portion to rotate can be provided by a location of thesuture tie relative to the connection points. One example of thisinteroperation is shown in FIG. 2A where the location of suture tie 213is off the center of the retrograde force body portion 211 while theconnector 214 and connection point is located in the center of bothbutton portions. As shown in FIG. 2B, a retrograde force on the suturetie 213 cause a force on the connector 214 that causes the expandablebody portion 212 to pivot and/or rotate at an angle different than thedirection of the retrograde force. Alternately, as shown in FIGS. 2C-2D,the location of the connection points on the expandable body portion tobe off-center while the suture tie is on the center line of the bodyportion.

It is also contemplated to have the shape of the body portions such thata retrograde force on the button causes the expandable body portion 212to pivot and/or rotate. For example, the expandable body portion canhave a barb or other protrusion on its expansion end that causes thatportion to rotate when partially retracted by the application of aretrograde force.

In some embodiments, the shape of the button can be made such that itminimizes the possibility of undesired protrusions when the button isdeployed. An undesired protrusion is a protrusion that can damage othertissues or bone. These undesired protrusions are different than thedesired protrusions caused the normal expansion of the button. Forexample, as in FIGS. 2A-2D, the shape of the button can be made so thatit is primarily a two-dimensional planar shape with a minimal profile ina third dimension. This allows the button to be inserted and to expandprimarily in dimensions parallel to particular surfaces, such as thearticular cartilage surfaces of the knee, while minimizing the potentialfor expanding perpendicular to those surfaces. This minimizes thepossibility of having protrusions that may damages these surfaces ortissues. It is also contemplated that the shape of the cannula can bemade to assist in the positioning of the button in deployment. This canbe provided by, but not limited to an inner bore shape of the cannulathat is primarily slot shaped to cooperate with a primarilytwo-dimensional shaped button. This would allow the profile of thebutton in the tissue to be controlled by the rotational position of thecannula. Other cooperating shapes of button and cannula bores arecontemplated such as ovals, circles and rectangles.

Referring back to the embodiment shown in FIG. 1, the suture anchorassembly also comprises a delivery system for the button 110 andretrograde force element 120. As shown in the embodiment in FIG. 1, thisdelivery system comprises a needle 133, a traction suture 132 and acannula 131.

The needle 133 is used to position and insert the button 110 andretrograde force element 120. The needle 133 comprises an elongated rodwith a sharpened distal end 134 and a proximal end 135 that has an eyeor other means to allow connection to the traction suture 132. As anexample, and not for limitation, 12 inch long needles made of stainlesssteel or Nitinol are suitable for use with this assembly.

The traction suture 132 is connected to the needle's proximal end 135and the button 110. Preferably, the traction suture is connected to atraction suture tie 115 on the sharpened end of button's expandable bodyportion 112. The traction suture 132 is used to connect the needle 133and the button 110 allowing the button to be pulled through the tissueand the defect to be deployed on one side of the defect. Any type ofsurgical suture or similar connection means is suitable for use as atraction suture with this assembly.

The retrograde force element 120 is connected to the force connector 113on a retrograde force body portion 111 of the button 110.

The cannula 131 is used to help position and deploy the needle 133. Thecannula 131 is a hollow element with a longitudinal extending bore toreceive the needle, the traction suture, the button and the expansionsuture. As an example, and not for limitation, 6 inch hollow cannula ofabout ⅜ inch in diameter is suitable for use with this assembly. In oneembodiment, the distal end of the cannula is bent at angles to helpguide the needles into the proper direction and position.

And although the delivery system embodiment described includes atraction suture connected to a traction suture tie and the eye of aneedle, other means to connect the needle and the button arecontemplated that include flexible, semi-flexible or substantially rigidconnecting elements. Examples of these connecting elements include butare not limited to a directly mating connection between the needle andthe button such as a threaded connection, one element hooking into aneye of another or one element clipping into a recess of another. Otherexamples of connecting elements include, but are not limited to aconnector connecting the needle and the button such as a flexible hook,chain, wire, rods or other means to removeably connect the two elements.

Alternative Button Embodiments:

Alternative embodiments of the button are shown in FIGS. 3A-5B.

FIGS. 3A and 3B illustrate one embodiment of the button 310. In theillustrated embodiment, the button 310 comprises an expandable firstbody portion 312 comprising expansion fingers 319, a collar 316 and aretrograde force body portion 311 that is shaped as a rod. Theretrograde force body portion 311 is connected to both the tractionsuture 332 and the retrograde suture 320 (retrograde force element) andis received into a collar 316. As shown in FIG. 3A, this embodiment isable to be inserted into a patient's body starting with the tractionsuture end. In the insertion position of FIG. 3A, the fingers arecompressed to minimize the profile of the assembly during insertion.When sufficient tension is placed on the retrograde force body portion311 from the retrograde suture side, the retrograde force body portion311 retracts towards the expandable body portion 312 and into the collar316, deploying the expansion fingers 319. The expansion fingers 319engage the retrograde force body portion 311 so that the fingers areurged to expand when the rod retracts. As shown in FIG. 3B, the fingershave an angled end 318A on the end that connects with a collar 316. Whenthe retrograde force body portion 311 is retracted, this angled end 318Ais rotated about a connection to the collar 316 forcing the expansionends 318B of the fingers 319 to expand. Other methods of cooperationbetween the fingers and the retrograde force rod so that the fingersexpand are contemplated to include any types of angles for the angledend 318A and any type of tethered connection to the collar that allowsthe fingers 319 to move and expand.

As shown in FIG. 3B, the deployment of the fingers 319 enables thebutton 310 to act as an obstruction and anchor for the retrograde suture320 connected to the button.

FIGS. 4A and 4B illustrate another embodiment of a button 410. In theillustrated embodiment, the button comprises an expandable first bodyportion 412 comprising a flexible hoop that is biased to expand and asecond retrograde force portion 411 shaped like a bar. The retrogradeforce body portion 411 is connected to the traction suture 432 and theretrograde suture 420. As shown in FIG. 4A, this embodiment is able tobe inserted into a patient's body starting with the traction suture endand the flexible hoop is folded back, or otherwise compressed againstits bias to expand and to minimize its profile during insertion. Whencompressed, the end of the flexible hoop nearest the traction suture isthe front end and the opposite end of the hoop is the expansion end.When placed in position, the expandable body portion 412 is expandedabout its front end by a trip or by the release of tension on the hoop.As shown in FIG. 4B, the expansion and deployment of the expansion endof the expandable body portion 412 enables the button 410 to engage thetissue and act as an obstruction and anchor for the retrograde sutureconnected to the button 410.

Embodiments of the buttons may include rigid buttons made of rigidbioabsorbable or resorbable materials such as but not limited topolyglycolic acid, polylactic acid enantiomers, poly-D-L-lactic acidcopolymer polyglycolic acid, a combination of polylactic acid andhydroxyapatite or materials such as collagen.

Embodiments of buttons may also include pliable buttons made of soft orpliable material or a rigid material configured, such as a rigidmaterial configured as a spring-like spiral or a woven mesh, to bend,fold, dilate, expand or otherwise deform upon application of a force onthe button. Embodiments of pliable buttons may be made of bioabsorbable,resorbable or non-resorbable materials. For illustration only, and notfor limitation, embodiments of a pliable button may be made of materialsincluding braided sutures, sponges and sponge-like materials in solidform, perforated materials, woven/braided from biocompatible materialsor fibers, such as, for example, polymer, polyester, polyethylene,cotton, silk, or other natural or synthetic materials, including spongesand sponge-like materials. The button may also be an elongated tubularor solid member or a two-dimensional member with or without internalbores. The button may have any properties that allow it to change shape.The button can be, for example, compliant, flexible, foldable,squashable, squeezable, deformable, limp, flaccid, elastic, low-modulus,soft, spongy, perforated or have any other flexible properties whichallow it to change shape.

The pliability of the button allows the button to deform uponapplication of a force. The deformation may be any change in shape thathelps the button become more secured in the tissue. For example, thedeformation may be to extend, swell, enlarge, expand, widen, dilate,distend, inflate or become larger and taking up more space in adimension that helps secure the button.

Two example embodiments of a generally tubular shaped pliable button areshown in FIGS. 10A and 10B. FIG. 10A illustrates a tubular sleeve shapedbutton 1010 having a first body portion 1012 and a second body portion1011. In this embodiment, the force connector 1013 is on the first bodyportion 1012. The first body portion 1012 also has a means to connectthe first body portion 1012 with the second body portion 1011 whereby aretrograde force on the force connector 1013 causes the button 1010 todeform and engage a tissue and secure the button 1010 in the tissue. Inthis embodiment, the means to connect the body portions is a middle bodyportion 1014 which is a continuation of the tubular sleeve between thetwo body portions and the force connector 1013 is a through holeextending through the wall of the button 1010. FIG. 10C illustrates oneembodiment of a suture anchor assembly having a button 1010, a tractionsuture 1032, a needle 1033 and a suture 1020. The means to connect theneedle to the first body portion by a suture tie which in thisembodiment also functions as the force connector 1013. This illustrationshows the assembly in a collapsed, insertion profile as it may lookwhile being inserted and pulled through a tissue by the needle 1033 andtraction suture 1032. FIG. 10D illustrates the embodiment of FIG. 10Cwith the traction suture and needle removed and a retrograde force F1being applied to the suture 1020 and the force connector 1013. In thisembodiment, the suture 1020 is the retrograde force element and itextends through a longitudinal inner bore of the button through a footconnector 1015. As shown, the button 1010 is deformed into a dilatedanchor profile shape that helps anchor the button in the tissue. As canbe seen, the foot connector 1015 is also shown which can retain thesecond body portion 1011 in relation to the first body portion 1012 sothat the button 1010 resists eversion (e.g. inverting or “flippinginside out”) as the retrograde force is applied. In this embodiment, thefoot connector 1015 is a through hole extending through the wall of thesecond body portion 1011 of the button 1010 and the foot connector 1015is sized similar to the force connector 1013 so that it restricts themovement of the second body portion 1011 with respect to the first bodyportion 1012 to resist the button 1010 inverting or everting. As canalso be seen, protrusions 1010P may also be formed in the deformationthat helps the button 1010 engage the tissue.

FIG. 10B illustrates one embodiment of a button 1010 comprising agenerally pliable weave or mesh tube. In some embodiments, the meshbutton can be a self-expanding button designed similar to self-expandingstents described in U.S. Pat. No. 6,719,934 issued Apr. 13, 2004 toJonathan S. Stinson which is herein incorporated by reference in itsentirety. These weave or mesh embodiments may incorporate the otherelements of buttons such as the force connector 1013, foot connector1015 as well as the first body portion 1012, second body portion 1011and the middle body portion 1014. Here the force connector 1013 and thefoot connector 1015 can be portions of the mesh, or special loops in themesh, that can be used to secure elements such as sutures.

FIG. 10E illustrates additional elements that may be used with thepliable button embodiments. As shown, this example suture anchorassembly has a second suture 1032-2 extending through the button 1010and connected to the second body portion 1011, here at the footconnector 1015, and a second needle 1033-2. This second suture 1032-2,as a forward force element, is able to apply a forward force F2 on thesecond body portion through the foot connector 1015. This forward forceF2, with or without an opposite retrograde force on the force connector,causes the button 1010 to deform into a dilated anchor profile shapethat anchors the button 1010 into the tissue. In this embodiment, thedeformation occurs closer to the position of the first body portion 1012which may be helpful in positioning the button.

FIGS. 11A-11D illustrates another embodiment of a pliable suture anchorassembly. As shown in FIG. 11A, this embodiment has a button 1110comprising a pliable generally planar sheet. This button 1110 has afirst body portion 1112 and a second body portion 1111. The first bodyportion 1112 has a force connector 1113 and has a means to connect thefirst body portion 1112 with the second body portion 1111 whereby aretrograde force on the force connector 1113 causes the pliable button1110 to deform and engage a tissue and secure the button in the tissue.In this embodiment, the means to connect the body portions is a middlebody portion 1114 is a continuation of the sheet between the two bodyportions and the force connector 1113 is a through hole extendingthrough the button. FIG. 11B illustrates one embodiment of the sutureanchor assembly having a button, 1110, a traction suture 1132, a needle1133 and a suture 1120 connected to the first body portion by a suturetie which in this embodiment is also the force connector 1113. Thetraction suture 1132 provides the means to connect the needle with thesuture tie and the first body portion. This illustration shows theassembly in a collapsed, insertion profile as it may look being insertedand pulled through a tissue by the needle 1133 and traction suture 1132.FIG. 11C illustrates the embodiment of FIG. 11B with the traction sutureand needle removed and a retrograde force F1 being applied to the suture1120, as the retrograde force element, and the force connector 1113. Asshown, the button 1110 is deformed into a dilated or folded anchorprofile shape that helps anchor the button 1110 in the tissue. As can beseen, a foot connector 1115, here a through hole, is also shown whichcan retain the second body portion in relation to the first body portionso that the button resists eversion as the retrograde force is applied.In this embodiment, the foot connector 1115 is sized similar to theforce connector 1113 so that it restricts the movement of the secondbody portion with respect to the first body portion and helps the buttonresist everting. In some embodiments, as shown, the retrograde forceelement is interwoven through multiple through holes, or footconnectors, along sections and alternating sides of the button whichpromotes dilated deformation and further preventing the button fromeverting.

FIG. 11D illustrates one embodiment where the anchor assembly furthercomprises a second suture 1132-2 extending through the button andconnected to the second body portion 1111, here at the foot connector1115, and a second needle 1133-2. This second suture 1132-2 as theforward force element is able to apply a forward force F2 on the secondbody portion 1111 through the foot connector 1115. This forward forceF2, with or without an opposite retrograde force on the force connector1113, causes the button 1110 to deform into a dilated shape that anchorsthe button 1110 into the tissue. In this embodiment, the deformationoccurs closer to the position of the first body portion 1112 which maybe helpful in positioning the button.

FIGS. 12A-12C illustrates another embodiment of a pliable suture anchorassembly. As shown in FIG. 12A, this embodiment has a button 1210comprising a pliable, generally spiraled or coiled element. This button1210 has a first body portion 1212 and a second body portion 1211. Thefirst body portion 1212 has a force connector 1213 and has a means toconnect the first body portion 1212 with the second body portion 1211whereby a retrograde force on the force connector causes the button 1210to deform and engage a tissue and secure the suture anchor assembly inthe tissue. In this embodiment, the means to connect is a middle bodyportion 1214 which is a winding of the coiled element between the twobody portions and the force connector 1213 is a closed loop in the firstbody portion 1212 of the button. FIG. 12B illustrates one embodiment ofthe suture anchor assembly having a button 1210, a traction suture 1232,a needle 1233 and a suture 1220 connected to the first body portion by asuture tie which in this embodiment also functions as the forceconnector 1213. The traction suture 1232 provides the means to connectthe needle with the suture tie and the first body portion. Thisillustration shows the assembly in a collapsed insertion profile as itmay look being inserted and pulled through a tissue by the needle 1233and traction suture 1232. FIG. 12C illustrates the embodiment of FIG.12B with the traction suture and needle removed and a retrograde forceF1 being applied to the suture 1220 (retrograde force element) and theforce connector 1213. As shown, the button 1210 is starting to deforminto a dilated anchor profile shape that helps anchor the button in thetissue. As can be seen, a foot connector 1215 is also shown which can beshaped to help resist eversion of the button 1210 as the retrogradeforce F1 is applied. Similar to the above embodiments, this embodimentmay have a second suture connected to the foot connector 1215 that canbe used as a forward force element to deform the button 1210 with aforward force.

FIGS. 13A-13C illustrate example embodiments of button as they may lookafter being deformed to anchor the button in the tissue. FIG. 13A is aperspective view of the example embodiment of the button of FIG. 10A ina dilated anchor profile. FIG. 13B is a perspective view of the exampleembodiment of the button of FIG. 11A in a folded anchor profile. FIG.13C is a side view of the example embodiment of the button of FIG. 12Ain a dilated anchor profile

The embodiments of anchoring sutures described above are also suitablefor anchoring sutures to other body parts such as bones. One embodimentparticularly suitable as a bone suture anchoring system is shown inFIGS. 5A and 5B and described below.

Suture Anchor Assembly in Bone:

Referring to FIGS. 5A and 5B, another embodiment of the suture anchorassembly comprises an expandable first body portion 512 comprising oneor more collars with expansion fingers 519, a second retrograde forceportion 511 shaped as a trochar, a delivery rod 520 and an impactor 531.Although not limited to, this embodiment is particularly helpful foranchoring sutures to bone.

In this embodiment, the retrograde force body portion 511 is shaped as awedge pin or trochar with sharpened distal end and a connectableproximal end including a force connector. In this embodiment, the forceconnector comprises a threaded portion to removably connect with thethreaded end of the delivery rod 520. This retrograde force body portion511 is preferably made from a rigid material such as a metal, plastic ora composite that allows a force to be applied to the threaded end whilethe sharpened end penetrates bone.

The delivery rod 520 is a rigid or semi-rigid element capable ofreceiving a force from one end of the rod and transferring that force toretrograde force body portion 511 of the button 510. The rod 520 iscable of receiving and transferring both a forward and retrograde forceto the retrograde force body portion 511. The distal end of the rod isconfigured to mate with the force connector of the retrograde forceportion of the button. In this embodiment, the delivery rod distal endis threaded to mate with the force connector. It is contemplated thateither of these elements may have the male or female elements of athreaded connection.

Although this embodiment has a delivery rod 520 that connects withretrograde force portion 511 of the button 510 with the use of threadedconnections, it is also understood that other means of connecting thedelivery rod 520 and the button 510 are possible such as but not limitedto mating clips, buttons, protrusions or other connection means.

In this embodiment shown in FIG. 5A, the expandable body portion 512comprises a proximal collar 517, a distal collar 516 each attached toone or more expanding fingers 519. The collars and fingers areconfigured so that when forces are applied to urge both collarstogether, the fingers 519 are forced to flexibly expand outward from thecenter of the body portion. FIG. 5B illustrates this embodiment in anexpanded configuration. This expansion creates the larger profile of thebutton 510. Although the fingers 519 are able to flexibly expand, theyare rigid enough to provide a frictional connection when expandedagainst bone or other tissue. The expandable body portion 512 of thisembodiment can be made of materials that include, but are not limited tometals, metal alloys or non-metallic materials such as nylon,polyethylene, polypropylene or any combination thereof.

In one embodiment, it is also contemplated that the shape of theretrograde force portion includes a hook, protrusion or other means toengage the proximal collar 517 so that the two collars can be retainedtogether and the fingers 519 can be kept in their expanded positionafter deployment. For one embodiment shown in FIG. 5C, the engagementmeans comprises one or more protrusions 511A on the retrograde forcebody portion 511 that compress when forced through one direction of thebore of the proximal collar 517 and expand to prevent the collar frommoving in the other direction to retain the collar in one positionrelative to the protrusions 511A. In this embodiment, the wedge shape ofthe distal end of the retrograde force body portion 511 creates a wedgeedge 511B that transfers the retrograde force against the distal collar516. The cooperation of the protrusions 511A engagement on the proximalcollar 517 and the wedge edge 511B against the distal collar 516 retainsthe button 510 in a position where the fingers 519 are maintained in anexpanded state after deployment. As shown in FIG. 5C, if there aremultiple protrusions 511A, the retrograde force body portion 511 willurge the collars together until the fingers expand fully into the defector bore and the protrusions will be retracted through the proximalcollar to engage the proximal collar 517 in a tight position. As alsoshown in FIG. 5C, a threaded recess 511C provides one means to connectthe delivery rod 520 with the retrograde force body portion 511. Alsoshown is FIG. 5C is an additional suture tie 511D to receive and securea suture to the anchor assembly.

The impactor 531 is a rigid or semi-rigid element capable of receiving aforce from one end of the impactor and transferring that force to theexpandable body portion 512. In the embodiment shown, the impactor 531is a rigid cannula with a longitudinal hollow bore to receive thedelivery rod 520. In this embodiment, the bore is shaped to allow thedelivery rod 520 to move within the bore while it is also shaped toprovide a resisting force on the proximal collar 517 of the button 510.The impactor 531 is shaped to allow the required force to be applied. Itis understood that this may require surfaces to either allow the forceto be applied frictionally or for the surfaces to be shaped to allow astriking force to be applied. For example, and not for limitation, theimpactor 531 may be shaped to have texture about its outer surface toallow the user to frictionally apply the forward force or it can includea flattened surface that would allow the impactor 531 to be struck by adevice such as a hammer.

In this embodiment, the cooperation of the elements allows the anchor tobe deployed without the need for a traction suture and needle.

It is understood and contemplated that the anchor elements, includingthe button elements, retrograde force elements and sutures, can be madewith both resorbable and non-resorbable materials and each one has itsindividual characteristics which allow it to work best in tissue or inbone such as cortical and cancellous bone.

Embodiments of the buttons may include rigid buttons made of rigidbioabsorbable or resorbable materials. For illustration only, and notfor limitation, the buttons may be made from polymers such aspolyglycolic acid, polylactic acid enantiomers, poly-D-L-lactic acidcopolymer polyglycolic acid, or a combination of polylactic acid andhydroxyapatite. In the later example embodiment, the polylactic aciddissolves in the body, and the hydroyxapatite may interact with thesurrounding tissue to promote bone growth that can help fill in theholes made for or by the buttons.

Embodiments of the buttons may also include rigid buttons made ofbioabsorbable or resorbable material such as collagen. In someembodiments, the button swells upon hydration and permits normal bonegeneration to assist in anchoring the button.

Embodiment of the buttons may also include rigid buttons have elementsbeing made of a combination of bioabsorbable material and non-absorbablematerial. In some of these embodiments, some elements may have surfacesthat are bioabsorbable, such as an exterior surface of the expansionfingers made of collagen, to help assist in anchoring the button intobone.

Meniscal Repair Method with Meniscal Suture Anchor Assembly:

One method of operating one embodiment of the suture anchor assemblyshown in FIG. 1 is shown as process steps in FIG. 6. Although particularembodiments of the suture anchor assembly are described, and particularuses of the methods are described, these uses and embodiments are usedfor illustration purposes and not for limitation. This method 600comprises the steps of:

Following the starting step 610, a suture anchor assembly is provided asstep 620. In one embodiment, the suture anchor assembly comprises aneedle, a traction suture, a button, a retrograde force connector and acannula. The needle is connected to the button with the traction sutureand the retrograde force connector is also connected to the button.

Step 630 includes making a small incision to provide access to thetissue to be repaired. For meniscal repair embodiments, this includesmaking a small incisions on either the medial or lateral joint line downto the outer lining of the joint capsule.

Step 640 includes inserting the needle and traction suture of the sutureanchor assembly through the cannula and joint lining and through thedefect in the meniscus. The needle is passed from the inside of thejoint to the outside while carefully protecting the neurovascularstructures.

FIG. 7A illustrates the use of one suture anchor assembly in step 640where the needle 733 is passed through a tissue 740, such as a meniscus,through the defect 741 and outside of the joint lining surface 742. FIG.7A shows the other elements of the suture anchor assembly prior topulling the button 710 and retrograde suture 720 (retrograde forceelement) into the meniscus 740 with the traction suture 732.

Step 650 includes pulling the button through the tissue with the needleand the traction suture. The button need not be pulled entirely throughthe tissue but may be pulled across the defect and into a position suchthat the button will anchor into the tissue on the opposing side of thedefect. The buttons are preferably not placed near significantneuro-vascular structures. The buttons are also placed to make sure itis buried in the tissue so that no sharp edges are exposed to othertissues or bone.

In one embodiment for meniscal repair, it is beneficial, but notnecessary, in this method to have the button shaped generally flat orplanar so that its profile once inserted can be generally parallel tothe surfaces of the knee joints to minimize the possibility ofprotrusions that would irritate the tissues of the joint. For controlpurposes, the hollow of the cannula can be shaped to receive the buttonand control its profile during insertion. For example, the button can beplanar shaped and the hollow of the cannula can be slot shaped allowinga rotation of the cannula to rotation the planar position of the button.

In one embodiment, of meniscal repair, the final position of the buttonsmay also be pulled totally through the meniscus to include but notlimited to, positions that rest on the outer surface of the meniscus orpositions outside of the joint capsule.

Step 660 includes applying a retrograde force on the retrograde forceelement to deploy the button and urge the tissue defect into the desiredposition. Typically, but not necessarily, this desired position is tourge opposing edges of a defect together. The retrograde force on theretrograde suture is transferred to a retrograde force to the buttonwhich forces the button to deploy and anchor the expansion suture.

It is not necessary to perform step 660 prior to adding a second buttonand retrograde force element.

Although not required, step 670 includes repeating the above steps(610-660) for at least a second time. For embodiments where theretrograde force element is a retrograde suture, the placement of theneedle and the retrograde suture into the tissue is such that it canform sutures such as, but not limited to vertical or horizontal mattresssutures to repair the meniscal defect.

Step 680 includes anchoring the retrograde force element to maintain thetissue defect in the desired position. For embodiments where theretrograde force element is a retrograde suture, the fixation arms ofthe sutures can be anchored by tying knots in or otherwise knotting thesutures separately or knotting the expansion sutures together to repairthe defect.

Step 690 includes removing the traction suture. The traction suture andneedle may be removed from the button at any time after the button ispositioned properly. One method of removal is to have the tractionsuture configured as a loop through both the button and the needlewhereby cutting one segment of the loop allows the entire suture to bepulled out of the button.

The method is finished with step 695.

In suture anchor assembly embodiments, such as those illustrated inFIGS. 10E and 11D that utilize a forward force to help anchor thebutton, the second suture is configured and inserted through the tissuesimilar to the traction suture. After the second suture is used toprovide the forward force and the anchor is properly positioned, thesuture is removed by cutting a section of the suture loop and pullingthe suture through the foot connector and out of the tissue.

The result of this embodiment for a miniscal repair, as illustrated in7B, are retrograde sutures 720 that are anchored on either side of aminiscal defect 741 to maintain the tissue 740 in a position to repairor promote healing of the defect. FIG. 7B shows two sutures 720A and720B anchored by two buttons 710A and 710B across the tissue defect 741.

With this embodiment of the method, incisions that are normally neededin the inside-out procedures to secure the fixation arms of the suturesare not needed. Additionally, the ability to use needles to position thebuttons and sutures allows more accurate position of the devices withinthe tissue and around neuro-vascular structures.

Other methods of use are contemplated as would be envisioned by thoseskilled in the art. For example, it is contemplated to have pre-tiedknots in the sutures to either create a knot in a single suture or totie two or more sutures together.

It is also contemplated that the method of using needles and tractionsutures to position the anchor can be used with other suture anchorsystems. Needles and elements to provide the function of the tractionsuture can be used with existing suture anchor systems.

It is also contemplated that the above method may be performed withoutthe need to use a needle and traction suture to position the button. Forthese embodiments, it is envisioned that the button may be manufacturedto include a distal end that can insert itself and the retrograde suturesufficiently or it can be designed to receive an element such as a guidepin that can be removed once the button is positioned properly. In theseembodiments, it is also envisioned that the cannula or other guide meanscan be designed to provide the force to position the button for meniscalrepair.

Although the above description is illustrative of the methods for usewith meniscal repair, it is also contemplated that the methods can beapplied to the repair of other tissues such as but not limited tostomachs and cartilage associated with joints such as a hip, elbow orshoulder.

Bone Anchoring Method with Bone Suture Anchor Assembly:

One method 800 of using one embodiment of the bone suture anchorassembly shown in FIG. 5 is outlined in FIG. 8 and described below.

Following step 810, a bone suture anchor assembly is provided in step820. In one embodiment, the assembly includes an expandable first bodyportion comprising one or more collars with expanding fingers, a secondretrograde force portion shaped as a trochar, a delivery rod and animpactor. As shown in FIG. 9A, the delivery rod 920 is connected to theproximal end of the retrograde force portion 9110. The delivery rod 920is received through the proximal collar 917 and distal collar 916 of theexpandable first body portion 912 and the impactor 931 is placed aroundthe delivery rod 920 forcing the expandable body potion 912 to bepositioned between trochar 9110 and the impactor 931.

Step 830 includes making an incision to provide access to the bone.

Step 840 includes positioning the sharpened end of the trochar againstthe bone and impacting the anchor assembly into the bone. This steptypically includes striking the delivery rod with a weighted object suchas a hammer. This forward force is transferred through the delivery rodto the sharp end of the trochar causing the trochar to penetrate thebone. In this step, the sharp trochar is inserted into the bone followedby the insertion of the expandable body portion. The size and shape ofthe trocar is such that its penetration of the bone forms a cavity of asize to allow the first body portion to also penetrate the bone.Embodiments of this assembly can be inserted into the bone with orwithout pre-drilling.

Once the trochar and expandable first body portion have penetrated thebone, step 850 includes applying a retrograde force the retrograde forceelement. In one embodiment, this retrograde force is applied by thedelivery rod that is connected to the trochar by the cooperation of thethreaded end of the delivery rod and the threaded end of the trochar.The application of this retrograde force subjects the trochar and thedistal end of the expandable body portion to that retrograde force whilethe proximal end of the expandable body portion is subjected to anopposite, forward force from the impactor. These opposing forces forcethe trochar to pass through the middle of the anchoring device until theouter dimension of the trochar can no longer fit the interior dimensionof the distal collar of the first body portion. When the trochar can nolonger pass, the retrograde force is transferred to the distal collarforcing the collar to move toward the proximal collar and expand thefirst body portion until the body portion can no longer expand. Thisanchor will expand until its profile generally fills the bore created bythe trochar. At that point the expanding trochar will stop itsretrograde progression. In this position, the anchor is frictionallyengaged and held in the bone bore.

Although step 850 includes pulling the trochar retrograde into theexpandable body portion, it is also contemplated that the anchorassembly can engage the tissue by maintaining the position of thetrochar and forcing the expandable body portion onto the shape of thetrochar. This forcing can be applied by the impactor and can also causethe expandable body portion to expand into the bore.

FIG. 9B illustrates this embodiment of the bone suture anchor assemblyhaving been impacted into the bone.

Step 860 includes removing the delivery rod from the trochar.

Step 870 includes attaching a suture or other surgical device to theanchor assembly's first or second body portion. The suture is attachedto the anchor assembly under tension which keeps the expandable bodyportion in an expanded position.

The method is finished with step 880.

The result of this embodiment is shown in FIG. 9B. The trochar 911(retrograde body portion) is retracted against the distal collar 916.The proximal collar 917 has been retained to urge the fingers 919 toexpand. Once expanded, the fingers 919 are frictionally engaged withinan opening 941 in the bone originally caused by the trochar 911 beingimpacted into the bone.

With respect to the above description then, it is to be realized thatthe optimum dimensional relationships for the parts of the invention, toinclude variations in size, materials, shape, form, function and mannerof operation, assembly and use, are deemed readily apparent and obviousto one skilled in the art, and all equivalent relationships to thoseillustrated in the drawings and described in the specification areintended to be encompassed by the present invention.

Therefore, the foregoing is considered as illustrative only of theprinciples of the invention. Further, since numerous modifications andchanges will readily occur to those skilled in the art, it is notdesired to limit the invention to the exact construction and operationshown and described, and accordingly, all suitable modifications andequivalents may be resorted to, falling within the scope of theinvention.

1. A suture anchor assembly comprising: a pliable button having a firstbody portion and a second body portion; the first body portion having aforce connector; and a means to connect the first body portion and thesecond body portion whereby a retrograde force on the force connectorcauses the pliable button to deform and engage a tissue and secure thepliable button in the tissue.
 2. The suture anchor assembly of claim 1further comprising: the second body portion having a foot connector; andthe foot connector is shaped to resist eversion of the pliable buttonwhen the retrograde force on the force connector causes the pliablebutton to deform.
 3. The suture anchor assembly of claim 1 furthercomprising: a needle; a traction suture connecting the needle to thefirst body portion; and a suture connected to the force connectorwhereby a retrograde force on the suture transfers a retrograde force onthe force connector.
 4. The suture anchor assembly of claim 1 whereinthe second body portion further comprises a foot connector whereby aforward force on the foot connector causes the pliable button to deformand engage the tissue and secure the suture anchor assembly in thetissue.
 5. The suture anchor assembly of claim 4 further comprising asecond suture connected to the foot connector whereby a forward force onthe second suture transfers the forward force to the foot connector andcauses the pliable button to deform and engage the tissue and secure thesuture anchor assembly in the tissue.
 6. The suture anchor assembly ofclaim 4 further comprising: a suture connected to the force connectorwhereby a retrograde force on the suture is transferred to the forceconnector; and a second suture connected to the foot connector whereby aforward force on the second suture is transferred to the foot connector.7. The suture anchor assembly of claim 1 wherein: the pliable buttoncomprises a pliable tubular member; the means to connect the first bodyportion and the second body portion comprises a middle body portion ofthe pliable tubular member; and the retrograde force on the forceconnector causes the pliable tubular member to deform from an insertionprofile to a dilated anchor profile.
 8. The suture anchor assembly ofclaim 7 further comprising: a needle; a means of connecting the needleto the pliable tubular member; a retrograde force element extendingthrough a longitudinal inner bore of the pliable tubular member; and theretrograde force element connected to the force connector whereby aretrograde force on the retrograde force element transfers theretrograde force to the force connector.
 9. The suture anchor assemblyof claim 7 further comprising: a needle; a means of connecting theneedle to the pliable tubular member; a foot connector proximal to thesecond body portion of the pliable tubular member; the foot connectorshaped to resist eversion of the button when the retrograde force on theforce connector causes the tubular member to deform; a retrograde forceelement extending through the foot connector; and the retrograde forceelement is connected to the force connector whereby a retrograde forceon the retrograde force element transfers the retrograde force to theforce connector.
 10. The suture anchor assembly of claim 7 wherein thepliable tubular member further comprises one or more protrusions on anexterior surface of the tubular member whereby the protrusions engagethe tissue and secure the anchor assembly to the tissue.
 11. The sutureanchor assembly of claim 1 wherein: the pliable button comprises apliable sheet; the means to connect the first body portion and thesecond body portion comprises a middle body portion of the pliablesheet; and the retrograde force on the force connector causes thepliable sheet to deform from an insertion profile to a folded anchorprofile.
 12. The suture anchor assembly of claim 11 further comprising:a needle; a means of connecting the needle to the pliable sheet; aretrograde force element extending alongside a portion of the pliablesheet; and the retrograde force element connected to the force connectorwhereby a retrograde force on the retrograde force element transfers theretrograde force to the force connector.
 13. The suture anchor assemblyof claim 11 wherein: the pliable sheet having a first side, a secondside, a length, and at least one foot connector extending through thefirst side to the second side; and a retrograde force element isinterwoven through the at least one foot connector and interwovenalongside the first and second side of the pliable sheet whereby theretrograde force on the force connector folds the pliable sheet aboutthe at least one foot connector into the folded anchor profile.
 14. Thesuture anchor assembly of claim 11 further comprising: a needle; a meansof connecting the needle to the pliable sheet; a foot connector proximalto the second body portion of the pliable sheet; the foot connectorshaped to resist eversion of the pliable sheet when the retrograde forceon the force connector causes the pliable sheet to deform; a retrogradeforce element extending through the foot connector; and the retrogradeforce element connected to the force connector whereby a retrogradeforce on the retrograde force element transfers the retrograde force tothe force connector.
 15. The suture anchor assembly of claim 1 wherein:the pliable button comprises a coiled element; the means to connect thefirst body portion and the second body portion comprises a middle bodyportion of the coiled element; and the retrograde force on the forceconnector causes the coiled element to deform from an insertion profileto a dilated anchor profile.
 16. The suture anchor assembly of claim 15further comprising: a needle; a means of connecting the needle to thecoiled element; a retrograde force element extending within the coiledelement; and the retrograde force element connected to the forceconnector whereby a retrograde force on the retrograde force elementtransfers the retrograde force to the force connector.
 17. The sutureanchor assembly of claim 15 further comprising: a needle; a means ofconnecting the needle to the coiled element; a foot connector proximalto the second body portion of the coiled element; the foot connectorshaped to resist eversion of the pliable button when the retrogradeforce on the force connector causes the coiled element to deform; aretrograde force element extending through the foot connector; and theretrograde force element connected to the force connector whereby aretrograde force on the retrograde force element transfers theretrograde force to the force connector.
 18. A suture anchor assemblyfor anchoring a suture in a tissue comprising: a pliable button having afirst body portion and a second body portion; a middle body portionconnecting the first body portion and the second body portion; a forceconnector connected to the first body portion; a foot connectorconnected to the second body portion; a retrograde force elementconnected to the force connector and extending through the footconnector; and the foot connector shaped to resist eversion of thepliable button whereby one of a retrograde force on the force connectoror a forward force on the foot connector causes the middle body portionto deform and engage a tissue and secure the pliable button in thetissue.
 19. The suture anchor assembly of claim 18 wherein: the pliablebutton is bioabsorbable; and the anchor assembly further comprises aforward force element connected to the foot connector whereby a forwardforce on the forward force element is transferred to the foot connector.20. A suture anchor assembly comprising: an expandable first bodyportion having a distal collar and a proximal collar; and a second bodyportion having a force connector whereby a retrograde force on the forceconnector forces the second body portion against the distal collar and aforward force on the proximal collar forces the first body portion toexpand to secure the suture anchor assembly in a tissue; the second bodyportion has a sharpened distal end to penetrate a bone; a delivery rodconnected to the force connector whereby a retrograde force applied tothe delivery rod is transferred to the second body portion; at least oneprotrusion of the second body portion to engage the proximal collar,retain the expansion of the first body portion; one or more expansionfingers positioned between the distal and proximal collar whereby whenthe first body portion expands, the expansion fingers flexibly expandoutward from the first body portion to secure the suture anchor assemblyin the bone; the expansion fingers having a bioabsorbable exteriorsurface; and the second body portion further comprises a suture tiewhereby the suture can be retained by the suture tie to the second bodyportion.